Efficacy and Safety of Full-endoscopic Decompression via Interlaminar Approach for Central or Lateral Recess Spinal Stenosis of the Lumbar Spine

Lee, Chang‐Hyun; Choi, Miyoung; Ryu, Dal Sung; Choi, In Suck; Kim, Chi Heon; Kim, Hyeun Sung; Sohn, Moon‐Jun

doi:10.1097/brs.0000000000002708

Cited by 105 publications

(89 citation statements)

References 25 publications

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“…Multiple studies 27,34,40,45,49,56 have demonstrated that endoscopic lumbar decompression in the setting of LSS provides equivalent outcomes to microsurgical or tubular techniques with shorter hospital stay and less collateral tissue injury. 2,40,41,47 The purpose of this study was to evaluate and compare the clinical efficacy of LE-ULBD and MIS-ULBD decompression in patients with LSS and coexisting degenerative deformity.…”

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confidence: 99%

Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

Hasan¹,

McGrath²,

Sen³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe management of lumbar spinal stenosis (LSS) with concurrent scoliosis and/or spondylolisthesis remains controversial. Full-endoscopic unilateral laminotomy for bilateral decompression (ULBD) facilitates neural decompression while preserving stabilizing osseoligamentous structures and may be uniquely suited for the treatment of LSS with concurrent mild to moderate degenerative deformity. The safety and efficacy of full-endoscopic versus minimally invasive surgery (MIS) ULBD in this patient population is studied here for the first time.METHODSA retrospective analysis of prospectively collected data was conducted on 45 consecutive LSS patients with concurrent scoliosis (≥ 10° coronal Cobb angle) and/or spondylolisthesis (≥ 3 mm). Patient demographics, operative details, complications, and imaging characteristics were reviewed. Outcomes were quantified using back and leg visual analog scale (VAS) scores and the Oswestry Disability Index (ODI) at 2 weeks, 3 months, and 1 year.RESULTSA total of 26 patients underwent full-endoscopic and 19 underwent MIS-ULBD with an average follow-up period of 12 months. The endoscopic cohort experienced a significantly shorter hospital length of stay (p = 0.014) and fewer adverse events (p = 0.010). Both cohorts experienced significant improvements in VAS and ODI scores at all time points (p < 0.001), but the endoscopic cohort demonstrated significantly better early ODI scores (p = 0.024).CONCLUSIONSEndoscopic and MIS-ULBD result in similar functional outcomes for LSS with mild to moderate deformity, while the endoscopic approach demonstrates a favorable rate of complications. Further studies are required to better delineate the characteristics of spinal deformities amenable to this approach and the durability of functional results.

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confidence: 99%

Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

Hasan¹,

McGrath²,

Sen³

et al. 2019

Neurosurgical Focus

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“…As a result, the prevalence of degenerative LSS is increasing.However, chronic pain and discomfort from LSS may signi cantly impair psychosocial function and induce sleep disorders, depressive symptoms, and increased utilization of health care (12). In recent years, PE has become the most minimally invasive treatment for lumbar degenerative disease, its indications are constantly being expanded, and it has proven e cacy for LSS (10,13). For elderly patients with LSS, while traditional surgical treatment can achieve extensive decompression and pain relief, it is associated with high risk and long recovery before resuming normal activities, and it takes longer to improve the quality of life.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients

Xie³

et al. 2020

Preprint

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Background: Although: percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods: In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (age 65-74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results: All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P<0.05). No statistically significant between-group differences were observed in operation time.

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“…Endoscopic laminectomy has been shown to have equal long-term outcomes when compared with open surgery with the potential for decreased postoperative pain, complications, and hospital length of stay. 10,12,13 Second, the study lacks a comparison group that underwent lumbar laminectomy via open or tubular means. However, the objective of this study was not to demonstrate the superiority of endoscopy over open or tubu-lar approaches, or vice versa.…”

Section: Discussionmentioning

confidence: 99%

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

Khalsa

Kim

Singh

et al. 2019

Neurosurgical Focus

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OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%–19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%–11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%–6.4%, p < 0.001) and 4.3% (95% CI 2.2%–6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3–10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.

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Efficacy and Safety of Full-endoscopic Decompression via Interlaminar Approach for Central or Lateral Recess Spinal Stenosis of the Lumbar Spine

Abstract: 2.

Cited by 105 publications

References 25 publications

Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

Clinical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

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